Does Online Therapy Actually Work? Doctors Weigh In

New apps promise unlimited access to therapists for a weekly fee. But do they work?

Text a therapist when you’re feeling stressed. Video chat a psychologist from the comfort of your home. Teletherapy—any therapy outside of the traditional office setting—has been around for decades, but new apps have raised new questions. Do the various platforms of online therapy actually work as well as traditional talk therapy? Or are they missing something crucial?

In 2015, I was wondering these things myself. I’d just lost my mother to cancer, and I was searching for help but struggling to find a good therapist in my area. I signed up for an online therapy program, and for just over a month communicated with a therapist via the app’s messaging system. Back then, it felt like a gamble: was online therapy even a real option, or just a millennial-inspired business plan doomed to fail?

The good news is these apps aren’t new anymore, and research and professionals have had time to noodle over whether online therapy is worth recommending. Here’s what you should know about whether online therapy actually works.

The benefits of online therapy

Most of the clear benefits of online therapy have to do with convenience, Sanam Hafeez, PsyD, a NYC based licensed clinical psychologist and founder and clinical director of Comprehensive Consultation Psychological Services, P.C, tells Woman's Day.

A few benefits include:

• Therapists are available quickly, with no travel required
• It may be less expensive (a traditional therapy appointment costs $30-$250 per session depending on where you live and whether your insurance covers it; apps like BetterHelp or TalkSpace start at $40 and $65 per week respectively)
• Some may find communicating online more comfortable

Dr. Seth Feuerstein, MD, JD, a lecturer and assistant clinical professor of psychiatry at Yale University, tells Woman's Day it’s important to remember that online therapy is just another form of communication—the bedrock of all good medical and mental health care. “Communication has obviously evolved over time as technology changes,” he says. “There's a lot of very good data that digitally enabled communication between providers and patients can absolutely be as effective as other means.”

Some of that research includes a meta-analysis of 64 studies published in the Journal of Anxiety Disorders in 2018, which found that online cognitive behavioral therapy was effective for major depression, panic disorder, social anxiety disorder, and general anxiety disorder.

There’s also the fact that many people haven’t been able to get quality care in the past, Dr. Feuerstein says. That could be because patients were nervous about setting up in-person visits, or for purely practical reasons: therapist schedules are full in their area or because it’s impossible to manage with their work schedule. “If you're an hourly worker and you need to take a few hours off from work every week to go see a therapist because it's in office, there's a high probability you're never going to get access to any care, and that's also a big problem,” he says.

In some ways, online therapy might offer more insight to tailor future therapeutic methods. “In some ways, it provides more data on effectiveness so that we're better able to demonstrate what works and what doesn't work,” he says.

The drawbacks of online therapy

Although it’s clear that online therapy can be effective, it still comes with cons. Hafeez has concerns about the ability of a therapist to properly evaluate a patient when the therapist can’t see their body language or grooming habits—something difficult to spot even on a video call.

Then, of course, there are also the glitches that come along with technology, as advanced as it may be. You might lose connection on your cell phone or your battery might die, for example. “Amid a patient’s big revelation, tech malfunctions are not a good thing,” she says.

Typing also has limitations, including that it’s usually slower than speaking, and that people may say less via text than they would in person, which gives the therapist less to work with, Hafeez explains.

Ultimately, that was my experience with online therapy. It was difficult to send a revealing message and then wait 24 hours for a response, which was often full of questions that felt challenging to answer in text—even, or maybe especially, as a writer. Video sessions weren’t as readily available then, and I didn’t have a private space to answer one anyway. Instead, I sought help elsewhere and realized I was craving the in-person relationship that comes with face-to-face therapy.

But that doesn’t mean it won’t be helpful for someone else.

What to consider before signing up for online therapy

According to the American Psychological Association (APA), there are several things you should consider before trying online therapy:

1. Is this the right tool for me and my situation?

“There's really not one answer that works for everyone,” Dr. Feuerstein says. “If somebody has psychosis, is manic, [or has] severe major depressive disorder, they need to be evaluated in person by a clinician, for instance.”

2. Is the therapist licensed, and licensed in the state you live in?

Many people may call themselves therapists or counselors but not have the appropriate training or licensing. Before working with a therapist, do your due diligence and confirm that they’re licensed in your state. BetterHelp states that they check to make sure their therapists are licensed, but you can also ask your therapist directly for their licensing information or check it on the Association of State and Provincial Psychology Boards.

3. Is the app or website secure?

At minimum, the APA recommends that you confirm the app or website you’re using complies with HIPAA rules and that it verifies both your identity and your therapist’s identity.

4. What are the costs?

Check ahead of time that you understand how much your insurance will cover, if anything, of your online therapy costs, and what kind of financial structure the app or website uses. For example, traditional therapy is typically billed “per session”—you’re charged each time you visit your therapist. Apps and websites often charge per week instead, in exchange offering “unlimited” access to a therapist. But if you’re not using the service regularly, you could end up spending more money than intended.

Ultimately, online therapy seems to be a good tool for many people, and patients can see for themselves whether it’s the right option for them.